• Georges Ntakiyiruta, Evan G Wong, Mathieu C Rousseau, Landouald Ruhungande, Adam L Kushner, Alexander S Liberman, Kosar Khwaja, Marc Dakermandji, Marnie Wilson, Tarek Razek, Patrick Kyamanywa, and Dan L Deckelbaum.
• From the Department of Surgery, University of Rwanda, Kigali, Rwanda (Ntakiyiruta, Ruhungande, Kyamanywa); the Department of Surgery, McGill University, Montreal, Que. (Wong, Rousseau, Liberman, Khwaja, Dakermandji, Wilson, Razek, Deckelbaum); the Centre for Global Surgery, McGill University Health Centre, Montreal, Que. (Wong, Rousseau, Razek, Deckelbaum); the Surgeons Overseas, New York, NY (Wong, Kushner); the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Kushner); and the Department of Surgery, Columbia University, New York, NY (Kushner).
• Can J Surg. 2016 Feb 1; 59 (1): 35-41.

BackgroundTrauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care.MethodsWe retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ² and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns.ResultsOver the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]).ConclusionTo our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.

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